Intensive care environment: Perspective of relatives of critically ill patient sustained by health technology

The intensive care unit(ICU)is a complex setting by nature,and some have described it as bizarre due to its numerous sirens that sound when anything is dangerous,constant activity,equipment,bright lights,and high fatality rate.The demands placed on nurses to care for critically ill patients in this environment frequently prevent nurses and other health‑care professionals from acknowledging the feelings of patient’s relatives or family caregivers,resulting in a hostile environment from the patient’s relative’s perspective.When a patient’s family enters the ICU,they feel that hospital administrators do little to nothing to alleviate their discomfort and fear.Despite research demonstrating the importance of providing a homely environment for patients’families,In Nigeria ICU is still far behind how a conventional ICU environment should be structured to accommodate patient’s relations in the unit.The goal of this study was to look at the patient’s relative’s perspective on providing care for a critically ill patient in an ICU,with a focus on the unit’s complexity and overall experience.Based on the findings of this study,we recommend that hospital administrators ensure that the environment of the upcoming ICU is designed to meet the needs of patient’s relatives by addressing identified environmental concerns,like caring neglect,by providing a friendly and stress‑free environment.

L-shell x-ray fluorescence relative intensities for elements with 62≤Z≤83 at 18 keV and 23 keV by synchrotron radiation

The relative intensities of L-subshell x-ray fluorescence(XRF)for elements with atomic numbers 62≤Z≤83 were measured at two excitation energies,18 keV and 23 keV,using a synchrotron radiation source at a beamline of the Synchrotron Light Center for Experimental Science and Applications in the Middle East(SESAME),Jordan.The experimentally measured results of the relative intensities were compared with the calculated results using the subshell fluorescence yield and the Coster-Kronig transition probabilities recommended by Campbell and the values based on the Dirac-Hartree-Slater model by Puri.The experimental and theoretical results are in agreement.In this work,L XRF relative intensities for the elements Sm,Gd,Tb,Er,Ta,W,Re,Hg,Pb and Bi at energies of 18 keV and 23 keV were measured.

Relationships Between the Distribution of Relative Canopy Light Intensity and the Peach Yield and Quality

The aim of the present experiment was to study the relationship between the distribution of relative light intensity in canopy and yield and quality of Wanmi peach. The optimum relative canopy light intensity was judged to be 36.3% for high quality peaches, when canopy volumes of Wanmi peach trees with a relative light intensity 〈 30% accounted for 7.7 and 47.9% of the total canopy volume in June and September, respectively. The canopy volume with a relative light intensity 〉 80% was 27.7 and 3.1% of the total canopy volume in June and September, respectively. Peach canopies were divided into 0.5 m × 0.5 m × 0.5 m cubes, with the relative light intensity being measured at different positions of the canopy during the growing season. Yield and fruit quality were also measured at these positions at harvest. The results showed that the relative light intensity decreased gradually from outside to inside and from top to bottom of the tree canopy. Fruit were mainly distributed in the upper and middle portions of the canopy, 1.5-3.0 m above ground. Regression results showed that single fruit weight and soluble solid content were positively related to relative light intensity.

The Distribution of Relative Light Intensity in a Peach Tree Canopy Affects Fruit Yield and Texture

Light is crucial to the uniform production of high-quality fruit since it is the driving force for leaf photosynthesis and hence overall plant nutrition.The objective of this study was to evaluate the relationship between the distribution of relative light intensity in the peach tree(Prunus persica)canopy and the yield and texture of peach fruits.The canopy of 7-year-old‘Qiuyan’was divided into cubical volumes and the relative light intensity distribution was measured for each cube,along with yield distribution and fruit textural properties at different growing times.The relative light intensity decreased gradually from outside to inside the canopy and from top to bottom.The yield distribution and the relative light intensity were clearly correlated.The percentage of the canopy receiving<30%relative light intensity was 49.07%in May,56.02%in June,and 58.95%in July,whereas the percentage receiving>80%relative light intensity was 32.72%,17.28%,and 10.96%,respectively.Consistent with this,peaches were found in the upper and middle portions of the canopy,within 1.5-3.0 m of the top.The regression equation showed that fruit texture index correlated significantly with relative light intensity.Relative light intensity is the main factor affecting peach yield and texture and must be above 41.83%for good peach quality.Orchardists should carefully plan summer pruning strategies to adjust the number and spatial distribution of branches accordingly.

Numerical simulation of four-wave mixing efficiency and its induced relative intensity noise

Four-wave mixing, as well as its induced intensity noise, is harmful to wavelength division multiplexing systems. The efficiency and the relative intensity noise of four-wave mixing are numerically simulated for the two-wave and the three-wave fiber transmissions. It is found that the efficiency decreases with the increase of both the frequency spacing and the fiber length, which can be explained using the quasi-phase-matching condition. Furthermore, the relative intensity noise decreases with the increase of frequency spacing, while it increases with the increase of fiber length, which is due to the considerable power loss of the pump light. This investigation presents a good reference for the practical application of wavelength division multiplexing systems.

Relative Intensity Noise in the Single Quantum Well Diode

Based on the mathematical model of quantum well laser diode(QW LDs) developed, the paper presents a relative intensity noise(RIN) model, which employs Gaussian form random noise with its average being to zero. It can be straightforwardly used to describe the effect of the noise on the performance of QW LDs. The RIN becomes notable in the frequency range of interests and therefore affects the device modulation property. The results are in good agreement of the published data. The RIN model proposed and the results can be used for purpose of device technique improvement and performance simulation of optical communication systems and networks.

Confidence Intervals for Relative Intensity of Collaboration(RIC)Indicators

Purpose:We aim to extend our investigations related to the Relative Intensity of Collaboration(RIC)indicator,by constructing a confidence interval for the obtained values.Design/methodology/approach:We use Mantel-Haenszel statistics as applied recently by Smolinsky,Klingenberg,and Marx.Findings:We obtain confidence intervals for the RIC indicatorResearch limitations:It is not obvious that data obtained from the Web of Science(or any other database)can be considered a random sample.Practical implications:We explain how to calculate confidence intervals.Bibliometric indicators are more often than not presented as precise values instead of an approximation depending on the database and the time of measurement.Our approach presents a suggestion to solve this problem.Originality/value:Our approach combines the statistics of binary categorical data and bibliometric studies of collaboration.

Crown Ratio and Relative Spacing Relationships for Loblolly Pine Plantations

Two loblolly pine (Pinus taeda L.) culture/density studies were established in 1995-1998 across the Lower Coastal Plain and Upper Coastal Plain/Piedmont regions of the southern USA. Each installation contains 12 plots of loblolly pine planted at six levels of density from 741 to 4448 trees/ha in combination with two levels of cultural intensity, operational and intensive. The data from 37 viable installations were used to evaluate the crown ratio and relative spacing relationship of loblolly pine plantations. The effects of planting density, site quality, and cultural intensity on the relationship were investigated with a nonlinear mixed-effects modeling approach. The crown ratio and relative spacing relationship is exceedingly predictable. When loblolly pine plantation stands reached the average live crown ratio of 0.40, a critical point representing a generally acceptable level of tree vigor, the corresponding relative spacing index ranged from 0.11 to 0.20, mainly depending on initial planting density. The information about the crown ratio and relative spacing relationship would be useful for selecting the best intensity and timing of thinning.

Investigation on the intensity noise characteristics of the semiconductor ring laser

Based on the frequency-domain multimode theoretical model, detailed investigations on the noise characteristic of the semiconductor ring laser （SRL） are first performed in this paper. The comprehensive nonlinear terms related to the third order nonlinear susceptibility Z3 are included in this model; the Langevin noise sources for electric field and carrier density fluctuations are also taken into account. As the injection current increases, the SRL may present several operation regimes. Remarkable and unusual low frequency noise enhancement in the form of a broad low frequency tail extending all the way to the relaxation oscillation peak is observed in any of the operation regimes of SRLs. The influences of the backscattering coefficient on the relative intensity noise （RIN） spectrum in typical operation regimes are investigated in detail.

Effects of hypoxic training on physiological exercise intensity and recognition of exercise intensity in young men

This study aimed to examine the effects of hypoxic training on physiological exercise intensity and recognition of exercise intensity in young men. The participants included 9 healthy young males (23.2 ± 6.5 years old, 176.2 ±6.7 cm, 74.3 ±16.4 kg). VO2 was measured during running with subjective exercise intensities of “somewhat hard” for 3 min and “fairly light” for 3 min. After the measurements, the participants answered the question “what percentage of your maximal effort was performed during both running exercises.” The exercise intensity recognition for the “fairly light” and “somewhat hard” intensities and the physiological exercise intensity measured by relative VO2 (%) and relative heart rate (HR, %) were then evaluated. The hypoxic training was performed 3 times a week for 4 weeks in a normobaric hypoxic chamber?(oxygen concentration, 15.4% and altitude, 2500 m). The participants ran at an exercise intensity of 60% VO2max for 40 min after a 5 min warm-up and then performed a 5 min cool-down. After training, they sat on a chair in the same room for 30 min. VO2max and HRmax changed significantly after the training. At “fairly light” intensity, the physiological measures were significantly higher than recognition of exercise intensity, with relative VO2 (%) increasing after training. In conclusion, hypoxia training causes an increase in VO2max and physiological exercise intensity during running at a “fairly light” intensity.

Study on the Attenuation Features of Earthquake Intensity in the Yunnan Region

This research on the attenuation features of intensity in the Yunnan region has been conducted by using intensity isoseismals of 127 earthquakes, and the following three conclusions have been put forward: (1) The average ratio value of long axis to short axis of innermost isoseismals in the Yunnan region is larger than that of eastern China and smaller than that of western China. The velocity of intensity attenuation varies in different directions; (2) The zoning feature of intensity attenuation in the Yunnan region is obvious; (3) In Northwest China and North China, the ratios of long axis to short axis of low magnitude isoseismals are larger than those of high magnitude ones. Compared with that phenomenon, the ratios in the Yunnan region are more complicated. Finally, some relevant questions are discussed.

Study on Related Factors of Acute Kidney Injury in Patients under Intensive Care

Objectives:To study the related factors of acute kidney injury(AKI)in intensive care unit(ICU)patients.Methods:The clinical data of 879 patients in the intensive care unit were retrospectively analyzed.AKI patients were selected according to the AKI clinical diagnostic criteria,the causal analysis was performed,the indicators of AKI patients were tested,and the urine volume and the time of admission to the ICU were recorded.Finally,logistic regression analysis was used to analyze the risk factors that affect the prognosis.Results:Among the 879 patients in the intensive care unit,96 patients(10.9%)met the KDIGO-AKI diagnostic criteria,of which 29(30.31%)died and 49(51.04%)required renal replacement therapy.As the age and stage of AKI patients increase,the mortality rate also increases.The pathology constituted 46 septic patients(47.92%)and 50 non-septic patients(52.08%).Patients with septic AKI have longer ICU and hospital stay than patients with non-septic AKI(t=2.291,0.023;t=2.082,0.041),and the rate of renal replacement therapy is higher(χ2=4.091,P=0.042).Logistic regression analysis shows that old age,low urine volume,shock,acidosis,stage 3 of AKI,intake of blood pressure drugs,infections,and the need for renal replacement therapy are relevant factors that affect AKI.Conclusions:In the intensive care unit,the incidence and mortality of AKI are very high;the treatment of AKI is related to many factors;early detection and treatment is very crucial to reduce the mortality of AKI.

重症患者导管相关性血流感染的病原菌分布与影响因素分析

目的探讨重症患者导管相关性血流感染(catheter-related bloodstream infection,CRBSI)的病原菌分布及影响因素。方法回顾性分析2019年7月1日至2022年7月2日期间在简阳市人民医院重症医学科接受中心静脉置管患者的临床资料,依据患者是否发生中心静脉CRBSI分为CRBSI组与非CRBSI组。对CRBSI组患者行病原菌种类分析,同时比较两组临床资料信息,并将有统计学意义的变量纳入多因素Logistic回归分析,明确接受中心静脉置管患者发生CRBSI的危险因素,通过受试者工作特征曲线(ROC)构建重症患者发生CRBSI的预测模型。结果共纳入接受中心静脉置管患者293例,其中CRBSI组38例、非CRBSI组255例。38例CRBSI患者共检出病原菌52珠,其中革兰氏阳性菌占比50.00%(26/52),以金黄色葡萄球菌19.23%(10/52)、表皮葡萄球菌7.69%(4/52)为主;革兰氏阴性菌占比44.23%(23/52),以大肠埃希菌17.31%(9/52)、肺炎克雷伯杆菌13.46%(7/52)为主;真菌占比5.77%(3/52),均为白色念珠菌。CRBSI组年龄≥60岁、合并糖尿病、置管部位为股静脉或颈内静脉、静脉营养液输液、置管前应用抗菌药物者占比显著高于非CRBSI组;CRBSI组BMI、入院时APACHEⅡ评分显著高于非CRBSI组,置管时间显著长于非CRBSI组,P值均<0.05。多因素Logistic回归分析结果显示,年龄≥60岁、高BMI、合并糖尿病、入院时高APACHEⅡ评分、置管部位为股静脉或颈内静脉、置管时间长、输液类型为静脉营养液、置管前应用抗菌药物为重症患者发生CRBSI的危险因素。ROC分析表明,BMI、入院时APACHEⅡ评分、置管时间均能用于重症患者发生CRBSI的预测,曲线下面积分别为0.778、0.919、0.975(P<0.05)。结论重症患者中心静脉置管后CRBSI的病原菌以金黄色葡萄球菌、大肠埃希菌较为多见,同时CRBSI的发生与年龄、BMI、置管天数、置管部位等因素关系密切,临床治疗过程中应当予以关注。

Care Measures and Health Outcomes in a Pediatric Intensive Care Unit in Brazil

Introduction: In low- and middle-income countries, including Brazil, conditions that favor mortality in the PICU remain significant. Compared to developed countries, there is a shortage of skilled human resources, lower availability of technological resources, greater difficulty of access and a higher incidence of infections, including both those acquired prior to admission and those resulting from treatment and hospitalization (i.e., healthcare-associated infections (HAIs)). HAIs in the PICU include ventilator-associated pneumonia and catheter-related bloodstream infections. Actions for the prevention of HAIs can minimize the occurrence of negative outcomes. Materials and Methods: This is an epidemiological study comparing admissions at the PICU of a high-complexity hospital in South Brazil over two three-year periods: 2012-2014 (before the measures were adopted) and 2015-2017 (after the measures). The care measures were adopted mainly at the beginning of 2015 and consisted of expansion of physical therapy care, adoption of care protocols, acquisition of new materials and equipment (transparent dressings for central catheters, high-tech mechanical ventilators and multiparametric monitors) and multidisciplinary team training. The frequency of the outcomes mortality, length of PICU stay, diagnosis of catheter-related bloodstream infection, need for and duration of ventilatory support and diagnosis of ventilator-associated pneumonia were compared between the two trienniums using logistic regression with adjustment for age in months and need of vasoactive drugs. Results: A total of 1140 admissions were analyzed (470 in the first triennium and 670 in the second), representing an increase in the admission rate of 42.6% after the adoption of the measures. After adjustments, significant reductions in the frequency of mortality (adjusted OR [adjOR] = 0.54;CI 95%: 0.34 - 0.84), length of PICU stay > 7 days (adjOR = 0.75;CI 95%: 0.57 - 0.97) and duration of ventilatory support > 7 days (adjOR = 0.54;CI 95%: 0.39 - 0.74) were observed. Conclusion: The results indicate the benefits of care measures for children admitted to the PICU in terms of a reduction in adverse events and expansion of access.

利伐沙班在预防导管相关性血栓中的作用

目的:对比利伐沙班和低分子肝素对重症监护室(ICU)患者导管相关性血栓(CRT)预防的影响。方法:选取2019年6月—2021年9月包头市中心医院ICU收治的120例符合中心静脉置管入组标准的患者作为研究对象,按随机数表法分为利伐沙班组、低分子肝素组和空白对照组,各40例。三组行深静脉穿刺置管后均给予深静脉导管常规护理,分别给予利伐沙班,低分子肝素及不抗凝处理。比较三组CRT发生率、不同时点的凝血指标[血浆纤维蛋白原(FIB)、D-二聚体(D-D)]及抗凝药物相关性出血的发生情况。结果:空白对照组CRT发生率显著高于利伐沙班组、低分子肝素组,差异有统计学意义(P<0.05),利伐沙班组和低分子肝素组CRT发生率比较,差异无统计学意义(P>0.05)。T_(2)、T_(3)和T_(4)时,利伐沙班组、低分子肝素组FIB、D-D低于T_(1)时,T_(3)和T_(4)时,利伐沙班组、低分子肝素组FIB、D-D低于T_(2)时,T_(4)时,利伐沙班组、低分子肝素组FIB、D-D低于T_(3)时,差异有统计学意义(P<0.05);T_(2)、T_(3)和T_(4)时,利伐沙班组FIB、D-D低于低分子肝素组及空白对照组,且低分子肝素组低于空白对照组,差异有统计学意义(P<0.05)。三组不同时间点FIB及D-D比较,差异有统计学意义(P<0.001);三组间FIB及D-D比较,差异有统计学意义(P<0.001);组间和时间存在交互作用(P<0.001)。低分子肝素组相关性出血总发生率高于利伐沙班组,差异有统计学意义(P<0.05)。结论:在ICU患者CRT的预防中,利伐沙班与低分子肝素均有效,但利伐沙班对凝血功能的改善效果更佳,安全性更高。

基于DRG的重症医学科病例费用结构比较分析及分组效能研究

目的探讨重症医学科(ICU)病例的住院费用构成及疾病诊断相关分组(DRG)分组效能。方法回顾性分析2019年1月1日至2022年12月31日在西安交通大学第一附属医院治疗的11378例ICU患者的入组情况,筛选出例数排名前10位的病组,分析该10组的费用结构;并采用变异系数评价ICU的前10位病组及全院相同病组。结果外科ICU的三个病组,主要费用构成为药费及耗材费,平均占总费用的69.82%。其余病组费用构成主要集中在药费及诊断费。前10位病组的分组效果较好(变异系数<1),但在相同DRG中,ICU出院患者组住院费用的变异系数普遍低于全院出院患者组,因此,对于相同DRG组,ICU出院患者单独评价时组内住院费用的同质性更高。结论建议进一步细化ICU相关分组,或建立切实可行的ICU患者补偿付费机制。在满足医保控费需要的同时,达到合理付费的目的。

乡村振兴背景下村庄建设用地集约利用研究——以南京为例

开展村庄建设用地盘活利用,对于激活农村土地资源资产、促进土地资源节约集约利用、破解乡村发展用地难题具有重要意义。文章以南京市乡村地区为研究对象,综合利用国土变更调查、镇村布局规划、“三区三线”划定等数据成果,运用定性、定量空间分析方法,分析乡村地区人地关系现状、村庄建设用地规模及空间分布,并对乡村地区村庄建设用地进行集约利用评价,为科学编制“多规合一”的实用性村庄规划、促进乡村振兴等工作提供数据基础和决策依据。

ICU患者医用粘胶相关性皮肤损伤发生风险预测模型的建立与验证

目的构建ICU患者医用粘胶相关性皮肤损伤(medical adhesive-related skin injuries,MARSI)发生风险列线图预测模型,并对其进行验证。方法选取2022年3-12月入住贵州省某三甲医院治疗的261例患者进行数据监测,通过logistic回归分析法筛选相关因素建立MARSI发生风险列线图预测模型,并采用受试者工作特征ROC曲线、校准曲线及决策曲线对预测模型进行拟合效应检验。结果回归分析结果显示:年龄、机械通气、APACHEⅡ评分、过敏史、发热、低蛋白血症、皮肤水肿及使用镇静剂是MARSI发生的影响因素。以此8个变量建立ICU患者MARSI发生风险列线图预测模型,模型的ROC曲线下面积为0.85(95%CI=0.824~0.886,C-index指数为0.85),模型拟合度检测(Hosmer-Lemeshow)χ2=4.621,P=0.797,预测值与实际值基本一致,此模型具有较好的预测效果。结论本研究构建的风险列线图预测模型具有较好的预测效果,可为临床护理人员预测ICU患者MARSI的发生风险,以尽早制订个性化预防策略提供参考。

ICU患者并发导管相关血流感染预测模型的构建与验证

目的探讨重症监护病房(ICU)患者并发导管相关血流感染(CRBSI)的危险因素,并构建其预测模型。方法选取2021年2月至2023年2月广东省第二人民医院收治的402例ICU住院患者,其中2021年2月至2022年9月的280例患者作为训练集构建预测模型,2022年10月至2023年2月的122例患者作为验证集进行外部验证。单因素和多因素logistic回归分析患者发生CRBSI的危险因素,构建基于危险因素的联合预测模型并绘制列线图,验证其准确性。结果训练集280例患者中有15例发生CRBSI(5.4%),验证集122例患者中有8例发生CRBSI(6.6%),2组CRBSI发生率差异无统计学意义(χ^(2)=0.227,P=0.634)。训练集中多因素分析显示,导管留置时间、导管滑动/滑出、白细胞、白蛋白是ICU患者发生CRBSI的独立危险因素(P<0.05)。列线图模型验证结果显示,训练集与验证集的C-index分别为0.904和0.877,曲线下面积分别为0.845和0.822。决策曲线分析显示,列线图在训练集和验证集有较好的临床获益性。结论基于CRBSI危险因素构建的列线图可预测ICU患者发生CRBSI风险,能帮助医护人员及时采取有效的干预措施。

以专科护士为主导的集束化护理预防骨科术后医用粘胶相关性皮肤损伤的效果

目的探讨以专科护士为主导的集束化护理对骨科术后患者医用粘胶相关性皮肤损伤(medical adhesive-related skin injury,MARSI)的预防效果。方法招募2022年6月至2023年12月邛崃市医疗中心医院骨科收治的限期或择期手术患者,随机分为对照组和研究组。对照组患者采用常规护理,研究组患者采用以专科护士为主导的集束化护理。观察比较两组的伤口敷料和静脉输液通道敷料MARSI发生率、康复效果(MARSI康复时间、下床活动时间和住院时间)和护理满意度。结果共纳入骨科术后患者400例,其中对照组和研究组各200例。研究组术后伤口敷料MARSI发生率(9.50%vs.20.00%,P<0.05)和静脉输液通道MARSI发生率(3.00%vs.13.50%,P<0.05)分别显著低于对照组。研究组MARSI康复时间[(10.27±0.08)d vs.(15.42±1.21)d,P<0.05]、下床活动时间([1.40±0.26)d vs.(3.72±0.38)d,P<0.05]和住院时间([8.41±0.21)d vs.(12.18±1.48)d,P<0.05]均显著短于对照组。研究组护理满意度(98.00%vs.82.50%,P<0.05)显著高于对照组。结论与常规护理比较,以专科护士为主导的集束化护理干预可显著降低骨科术后患者MARSI的发生率,促进康复效果,提升患者护理满意度,具有一定临床应用价值。